Restless

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Nov 26, 2007

In my last post I casually mentioned my post-transfer stroll down a busy Minneapolis street to hail a cab. (I also casually mentioned a giant rabbit, Darth Vader, and Enya, so you know I must have been high.) In the comments, bogart wrote:

"Thank you for walking and hailing the cab and posting about it…There is not one single published study that supports limiting activity/mobility after transfer. The ways REs ignore that fact drives me nuts!"

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You and me both, sister. There's a long list of things medical personnel do that make me crazy: not remembering my name, failing to read my chart, safely tucking their prescription pad in a pocket when they leave the examination room instead of tossing it carelessly on the counter for me to appropriate, that kind of thing. But near the very top of that list is prescribing post-transfer bed rest.

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Many clinics do so. Mine, for example, directed me to observe 48 hours of bed rest after transfer. Two days! 48 hours of doing nothing more strenuous than getting up to go to the bathroom. Even taking a shower was forbidden, I guess because all that standing up and lathering and, my God, just think of the rinsing could prevent implantation.

Not, as bogart mentioned above, that there is any proof that it does. In fact, studies have shown quite the contrary: There was no improvement in pregnancy rates when patients observed 24 hours of bed rest versus 1 hour. Another study suggests that not even that hour is necessary, with patients who rested for only 20 minutes experiencing similar outcomes to those who rested for a whole day.

But it gets better. In other investigations, outcomes for patients who got up immediately after transfer were just as good as for those who rested for 30 minutes or an hour. So not only was there no good reason for me to be borne to my hotel immobilized on a stretcher, there was no good reason for me to lie impatiently in the recovery room, leafing through last week's People, pretending to call a cab. ("Yes, hello? Imaginary Taxi? I'd like to schedule a pickup. Oh, good, you can teleport here instantaneously, circumventing the snarl of traffic while breaking all known laws of matter, allowing me to get off this gurney right this minute? And what color vehicle should I look for? Invisible! Splendid. That's my very favorite color of all.")

Prominent reproductive endocrinologist Dr. David Sable wrote back in 2000: "…We recommend lying down for 30 minutes after transfer. I fully believe that is 28 minutes too long…I've long proposed a research study where we had half of our patients jump up and down on a trampoline after embryo transfer to prove that activity was unimportant. I fear, however, that I may have difficulty convincing patients to sign the consent form for that study."

And in that last sentence lies the crux of the matter. By the time we make it to an IVF transfer, we've been through enough that we're doggedly committed to doing everything we can to foster success — and certainly intent on making sure we don't do anything to prevent it. But I wonder sometimes whether we take that inclination too far. We want to believe we have some control. But beyond continuing progesterone, taking prenatals, and getting good medical care — the few things that have been proven to work in establishing and prolonging a healthy pregnancy — isn't it out of our hands?

I'm sure our doctors know this, even as they tell us to rest. I think that advice is nothing more than the conventional wisdom that gets applied by worried infertiles to everything from taking a bath during the two-week wait to traveling during the first trimester to eating Philadelphia cream cheese: "Don't do anything you'd regret if you ended up with a bad outcome." The idea is to make it emotionally easier for women who might blame themselves for doing something wrong if they should suffer a failed cycle or a miscarriage. I applaud the intent; I just wish we were all better educated about what constitutes a risk and what does not, and that we had a better understanding of what we can control versus what we can't.

Overall, I'm not really a worrier or a blamer. If I am pregnant, I won't think it's because I rested for half an hour; if I'm not, I won't think it's because I lifted a suitcase the next day. When you get right down to it, I am a bather, a traveler, and an unapologetic cheese-eater. On transfer day, I was a walker and a cab-hailer. And I might even have been a trampoline-jumper if I hadn't been so busy taking that deadly, deadly shower.

How do you feel about post-transfer bed rest? Does your clinic require it, and do you comply? Does it make you feel better to take it easy? Or do you prefer to be up and around? Do you do anything different to forestall regret?